Monitoring of patients treated with lithium for bipolar disorder: an international survey
Nederlof, M.; Heerdink, E. R.; Egberts, A. C.G.; Wilting, I.; Stoker, L. J.; Hoekstra, R.; Kupka, R. W.
(2018) International journal of bipolar disorders, volume 6, issue 1
(Article)
Abstract
Background: Adequate monitoring of patients using lithium is needed for optimal dosing and for early identification of patients with (potential) ADEs. The objective was to internationally assess how health care professionals monitor patients treated with lithium for bipolar disorder. Methods: Using networks of various professional organizations, an anonymous online survey
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was conducted among health care professionals prescribing lithium. Target lithium serum levels and frequency of monitoring was assessed together with monitoring of physical and laboratory parameters. Reasons to and not to monitor and use of guidelines and institutional protocols, and local monitoring systems were investigated. Results: The survey was completed by 117 health care professionals incorporating responses from twenty-four countries. All prescribers reported to monitor lithium serum levels on a regular basis, with varying target ranges. Almost all (> 97%) monitored thyroid and renal function before start and during maintenance treatment. Reported monitoring of other laboratory and physical parameters was variable. The majority of respondents (74%) used guidelines or institutional protocols for monitoring. In general, the prescriber was responsible for monitoring, had to request every monitoring parameter separately and only a minority of patients was automatically invited. Conclusions: Lithium serum levels, renal and thyroid function were monitored by (almost) all physicians. However, there was considerable variation in other monitoring parameters. Our results help to understand why prescribers of lithium monitor patients and what their main reasons are not to monitor patients using lithium.
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Keywords: Bipolar disorder, Lithium, Monitoring, Survey, Therapeutic drug monitoring, alanine aminotransferase, albumin, aspartate aminotransferase, bilirubin, calcium, creatinine, glucose, high density lipoprotein, lithium, low density lipoprotein, parathyroid hormone, potassium, sodium, thyrotropin, thyroxine, triacylglycerol, urea, very low density lipoprotein, alanine aminotransferase blood level, albumin blood level, article, aspartate aminotransferase blood level, bilirubin blood level, bipolar disorder, blood pressure, body mass, calcium blood level, cell differentiation, cholesterol blood level, clinical protocol, creatinine blood level, electrocardiogram, general practitioner, glomerulus filtration rate, glucose blood level, health survey, high density lipoprotein cholesterol level, human, kidney function, leukocyte count, lithium blood level, liver function, low density lipoprotein cholesterol level, maintenance therapy, medical society, nurse practitioner, parathyroid hormone blood level, patient monitoring, potassium blood level, practice guideline, pregnancy test, prescription, psychiatrist, pulse rate, questionnaire, resident, sodium blood level, thyroid function, thyrotropin blood level, thyroxine blood level, triacylglycerol blood level, urea blood level, urinalysis, waist circumference, Psychiatry and Mental health, Biological Psychiatry
ISSN: 2194-7511
Publisher: Springer Open
Note: Publisher Copyright: © 2018, The Author(s).
(Peer reviewed)